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Background: Tadalafil, commonly prescribed for benign prostatic hyperplasia (BPH), may benefit patients with Type 2 diabetes mellitus (T2DM) for glycemic markers and complications. However, the association between the long‐term use of tadalafil and the incidence of T2DM has not been investigated. Methods: We emulated a target trial of tadalafil use (5 mg/day) and the risk of T2DM using a population‐based claims database in Japan. Patients who initiated tadalafil or alpha‐blockers for BPH and had no history of diabetes diagnosis, no dispensing of glucose‐lowering drugs, and no history of hemoglobin A1c levels of ≥6.5% (47–48 mmol/mol) were included. The primary outcome was the incidence of T2DM. Pooled logistic regression was used to estimate adjusted risk ratios (RRs) and 5‐year cumulative incidence differences (CIDs). Results: A total of 5180 participants initiated tadalafil treatment and were compared with 20,049 patients who initiated alpha‐blockers. The median follow‐up time for each arm was 27.2 months (interquartile range [IQR], 12.0–47.9) in tadalafil users and 31.3 months (IQR, 13.7–57.2) in alpha‐blocker users. The incidence rates of T2DM in tadalafil and alpha‐blocker users were 5.4 (95% confidence interval [CI], 4.0–7.2) and 8.8 (95% CI, 7.8–9.8) per 1000‐person years, respectively. Initiation of tadalafil was associated with a reduced risk of T2DM (RR, 0.47; 95% CI, 0.39–0.62; 5‐year CID, −0.031; 95% CI, −0.040 to −0.019). Conclusion: The incidence of T2DM was lower in men with BPH treated with tadalafil than in those treated with alpha‐blockers. Thus, tadalafil may be more beneficial than alpha‐blockers in preventing T2DM. [ABSTRACT FROM AUTHOR]

Background: Vibration platforms have demonstrated systemic effects generated by the use of mechanical vibrations, which are similar to those of any physical activity. The effect that whole body vibration (WBV) generates on the organism could be recommended in Diabetes Mellitus 2 (DM 2) patients. Objective: To systematically review and meta-analyze the available evidence on the effects of WBV on glycemic control in patients with DM 2 Material and methods: Exhaustive bibliographic searches were carried out until October 2023 in different biomedical portals and databases: Public Medline (PubMed), Scientific Electronic Library Online (SciELO), VHL Regional Portal, Cochrane Central and Latin American and Caribbean Literature in Health Sciences (LILACS). Randomized clinical trials based on the effects of Whole Body Vibration on glycosylated hemoglobin levels, with control group and participants were non-insulin dependent were the inclusion criteria. Two reviewers extracted data independently. A third reviewer was available for discrepancies. Results: Six articles with 223 participants met the criteria and were included in the systematic review; only four of them met the criteria to be part of the metaanalysis. This meta-analysis reveals a positive and significant effect size (m ê =0.5731), indicating a substantial difference between the groups studied. Although there is some variability between studies (heterogeneity of 30.05%), the overall direction of the effects is consistent. These findings conclusively suggest the presence of a significant influence of the variable evaluated, underscoring the robustness and consistency of the relationship observed in the literature reviewed. Conclusion: There are no conclusive results due to the lack of data for some variables, which prevents comparison; but WBV may be an effective therapy to improve glycemic control in DM 2 patients. More studies with more patients and longer follow-up are needed. [ABSTRACT FROM AUTHOR]

Metabolic disorders (MDs) include disease states such as diabetes mellitus, obesity, dyslipidemia, hyperuricemia, etc., affecting about 30% of the planet's population. The purpose of the present study was to investigate the protective potential of Cicerbita alpina leaf extract (ECA) against chemically induced type 2 diabetes in Wistar rats. Additionally, some biochemical parameters in the blood serum and liver, as well as histopathological investigation, were also performed. Quantitative analysis of the major compounds in the used extract was performed using ultrahigh-performance liquid chromatography-diode array detection (UHPLC-DAD) analyses using the external standard method. C. alpina extract revealed a beneficial effect on MDs, lowering blood sugar levels and MDA quantity in the liver, increasing the reduced glutathione level, and increasing antioxidant enzyme activity. Cichoric acid (CA) (91.93 mg/g dry extract (de) ± 4.64 mg/g de) was found to be the dominant compound in the extract, followed by caftaric (11.36 ± 2.10 mg/g de), and chlorogenic acid (CGA) (9.25 ± 0.05 mg/g de). In conclusion, C. alpina leaf extract (ECA) is rich in caffeoyltartaric and caffeoylquinic acids and provides beneficial effects on the diabetic animal model. [ABSTRACT FROM AUTHOR]

Background: Irisin was found to correlate with coronary artery disease (CAD) in diabetic patients. This study investigated the association of irisin and FNDC5 (SNP rs3480) with the presence and severity of CAD in T2DM. Methods: This cross-sectional study included 100 patients with T2DM divided into two groups, DM group (n = 50), including patients without CAD and CAD group (n = 50), including those confirmed to have CAD by coronary angiography. Irisin was measured. SNP rs3480 genotyping of FNDC5 was done. Results: Irisin levels were significantly lower in the CAD group (p < 0.001). The CAD group had significantly higher HbA1c and lower HDL (p < 0.001). Patients with controlled DM had significantly higher irisin levels (p < 0.001). single nucleotide polymorphism (SNP) rs3480 was not associated with irisin levels, and the FNDC5 rs3480 AA reference allele was significantly associated with significant CAD. Conclusion: Irisin appears to be protective against developing CAD in diabetic patients. Irisin level was an independent predictor of significant CAD in diabetic patients combined with the FNDC5 rs3480 genotype. Clinical trial registration number: NCT04957823 [ABSTRACT FROM AUTHOR]

Momordica charantia L. saponins (MCS) may promote wound-healing properties but the underlying mechanisms are unclear. This study aimed to examine the effects and mechanisms of MCS on diabetic wounds. The results have shown that higher MCS intake lowered fasting blood glucose levels, serum lipids, and lipopolysaccharides in diabetic mice. MCS-treated diabetic mice exhibited faster wound healing than the diabetic control groups. After three days, the diabetic control groups exhibited a wound area reduction of only 19.3%, while a 39.75% reduction was observed following high-dose MCS treatment. Five potential biomarkers were screened in the metabolomics study. The results revealed that MCS mainly regulated glycerophospholipid metabolism, fructose and mannose metabolism, steroid hormone biosynthesis, pyrimidine metabolism, and the Krebs cycle, thus affecting wound healing. Overall, MCS could not only exert a hypoglycemic effect but also promote diabetic wound healing, making it a potential treatment option for diabetes-related wounds. [ABSTRACT FROM AUTHOR]

Introduction: The Diabetes Prevention Program (DPP) is effective; enrollment is low. Little research has examined factors driving individuals' enrollment decisions. Methods: In our final survey of a randomized trial comparing methods to increase enrollment in the DPP, we asked participants about factors impacting enrollment. We conducted interviews with a subgroup. Results: Participants who completed the survey (n = 299) were primarily female (96 male); middle-aged (mean 52.9, SD = 14.7); white (86%); non-Hispanic (85%). Only 19% reported awareness of the DPP prior to the study. Cost, online availability, and behavior-change motivation were the most highly rated factors influencing enrollment. The median amount participants were willing to pay for the program was $66.50. Phone interviews included 17 individuals who were/were not interested in receiving a referral to the DPP. Those interested described risk awareness, family history, social support, and healthcare-provider influence as facilitating enrollment. Cost, time, travel, unsupportive family, incomplete knowledge about the program's impact and low self-efficacy were barriers. Among those uninterested, some were already engaging in lifestyle change, and some didn't see a benefit. Conclusions: Results suggest that, even among high-risk individuals, efforts to increase awareness and benefits of the DPP are needed, as are efforts to address cost of enrollment and low motivation. Trial Registration: ClinicalTrials.gov protocol ID: 00132307. The Effect of 360 Video and MAPS on Enrollment in the DPP. URL: https://www.clinicaltrials.gov/study/NCT04746781?id=00132307&rank=1. [ABSTRACT FROM AUTHOR]

Objectives. The health consequences of adolescent obesity are understudied in young adult Israeli Arabs. We aimed to evaluate the association of weight categories during adolescence with hypertension (HTN), diabetes mellitus type 2 (DM2), and the composite endpoint of ischemic stroke (IS), myocardial infarction (MI), and heart failure (HF) in young adult Israeli Arabs on a nationwide level. Methods. A retrospective cohort study of 53,726 Arab adolescents born from 1988–1992 was conducted. The cohort was followed, beginning with BMI measurements at ages 17–19 years, until whichever came first among the diagnosis of outcome disease, death, discontinuation of health insurance, or age of 30 years. Results. The incidence (95% CI) of HTN, DM2, and the composite endpoint of IS, MI, and HF was 138.2 (129.1–147.9), 136.7 (127.6–146.3), and 27.3 (23.3–31.7) cases per 105 person-years, respectively. The risk for DM and HTN increased gradually, starting from the 'overweight' category, and reaching fully adjusted HRs (95% CI) of 2.80 (1.82–4.30), and 1.97 (1.31–2.96), respectively, in the 'class 3 obesity' category. The Hazard ratio (HR) for the composite endpoint, its incidence and components, was highest in the 'overweight' category (aHR of 1.64 (1.08–2.50)). Conclusions. The findings emphasize the long-term health consequences of adolescent obesity in early adulthood and, hence, the need for interventions aimed at reducing the rate of adolescent overweight and obesity. The finding of a very high rate of DM2 incidence in early adulthood, even among adolescents without obesity, necessitates an integrated public health approach to all risk factors to prevent DM2 in this population. [ABSTRACT FROM AUTHOR]

Given the posited role of oxidative stress in the pathogenesis of both periodontitis and type 2 diabetes mellitus (T2DM), it may also serve as a link between these highly prevalent chronic inflammatory diseases. This view is supported by an ample body of evidence indicating that the severity and progression of periodontitis is in part driven by diabetes, while periodontal infection may hinder the attainment of adequate glycemic control in diabetic patients. Thus, this review focuses on the potential synergistic interactions along the oxidative stress–inflammation pathway characterizing both conditions. Because periodontitis and T2DM share the same risk factors and compromise patients' quality of life, to develop effective strategies for combatting both conditions, their mutual influence needs to be explored. [ABSTRACT FROM AUTHOR]

Aim: To investigate the efficacy of Palmitoylethanolamide (PEA, 300 mg), Superoxide Dismutase (SOD, 70 UI), Alpha Lipoic Acid (ALA, 300 mg), vitamins B6 (1.5 mg), B1 (1.1 mg), B12 (2.5 mcg), E (7.5 mg), nicotinamide (9 mg), and minerals (Mg 30 mg, Zn 2.5 mg) in one tablet in people with Diabetic Neuropathy (DN). Patients–methods: In the present pilot study, 73 people (age 63.0 ± 9.9 years, 37 women) with type 2 Diabetes Mellitus (DMT2) (duration 17.5 ± 7.3 years) and DN were randomly assigned to receive either the combination of ten elements (2 tablets/24 h) in the active group (n = 36) or the placebo (n = 37) for 6 months. We used the Michigan Neuropathy Screening Instrument Questionnaire and Examination (MNSIQ and MNSIE), measured vibration perception threshold (VPT) with biothesiometer, and Cardiovascular Autonomic Reflex Tests (CARTs). Nerve function was assessed by DPN Check [sural nerve conduction velocity (SNCV) and amplitude (SNAP)]. Sudomotor function was assessed with SUDOSCAN, which measures electrochemical skin conductance in hands and feet (ESCH and ESCF). Pain score (PS) was assessed with Pain DETECT questionnaire. Quality of life was assessed by questionnaire. Results: In the active group, there was a large improvement of pain (PS from 20.9 to 13.9, p < 0.001). There was also a significant improvement of vitamin B12 (B12) levels, MNSIQ, SNCV, VPT, and ESCF (222.1 vs. 576.3 pg/ mL, p < 0.001; 6.1 vs. 5.9, p = 0.017; 28.8 vs. 30.4, p = 0.001; 32.1 vs. 26.7, p = 0.001; and 72.2 vs. 74.8, p < 0.001 respectively). In the placebo group, neither pain (21.6 vs. 21.7, p = 0.870) or any other aforementioned parameters changed significantly, and MNSIE worsened (2.9 vs. 3.4, p < 0.001). As a result, changes from baseline to follow-up in pain, B12 levels, VPT, and MNSIQ differed significantly between the two groups (p < 0.001, 0.025, 0.009, and <0.001, respectively). CARTs, SNAP, ESCH did not significantly change in either of the two groups. Conclusions: The combination of the ten elements in one tablet for 6 months at a daily dose of two tablets in people with DN significantly improves pain, vibration perception threshold, and B12 levels. [ABSTRACT FROM AUTHOR]

Background: Reducing the frequency of self-monitoring of blood sugar, due to needle phobia, pain, stress, and costs associated with the procedure, can improve patient compliance and quality of life, provided that adequate blood sugar control is maintained. This study aimed to evaluate the effect of low-frequency blood glucose self-monitoring (LFBGSM) on glycosylated hemoglobin (HbA1C) levels among older adults living with type 2 diabetes mellitus (T2DM), treated with or without insulin. Materials and Methods: This randomized controlled trial with a parallel design was conducted on 121 older adults with T2DM in Sabzevar, Iran, between 2018 and 2020. Initially, subjects were stratified based on the type of treatment (with or without insulin) and then randomly assigned to intervention (LFBGSM) and control (no blood glucose self-monitoring [no-BGSM]) groups. HbA1C levels were measured at the beginning of the study and 3 months later for all study groups. Results: The mean age of participants treated with and without insulin was 64.3 ± 9.60 and 64.7 ± 5.01 years, respectively. The ANCOVA test revealed a significant difference in the mean HbA1C levels among the four groups 3 months postintervention (P < 0.001). The HbA1C scores significantly decreased in the LFBGSM groups and increased in the no-BGSM groups at 3 months postintervention (insulin/LFBGSM, insulin/no-BGSM, noninsulin/LFBGSM, and noninsulin/no-BGSM: 7.74 ± 0.76, 8.34 ± 1.53, 7.70 ± 0.75, and 8.14 ± 1.11, respectively) compared to baseline (8.25 ± 0.67, 8.03 ± 0.64, 8.08 ± 0.69, and 7.83 ± 0.74, respectively). The least significant difference post hoc tests showed significant differences between specific groups, emphasizing subtle responses to interventions (P values ranging from 0.001 to 0.929). Conclusion: Findings suggest a significant reduction in HbA1C scores within the LFBGSM groups, while a discernible increase is observed in the no-BGSM groups over the 3 months. These findings underscore the efficacy of the interventions and emphasize the crucial role of personalized approaches in optimizing glycemic control for individuals with diabetes. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has caused severe health issues worldwide and contributed to huge financial losses. Key comorbidities linked to an increased risk of severe COVID-19 and higher mortality rates include cardio-metabolic disorders such as type 1 and type 2 diabetes mellitus (T1DM and T2DM), atherosclerotic cardiovascular disease, chronic kidney disease, hypertension, heart failure, and obesity. The persistence of symptoms even after the acute phase is over is termed long COVID-19 syndrome. This study aimed to evaluate the relationship between long COVID-19 syndrome and the development of insulin resistance in previously non-diabetic patients. Methods: A prospective observational study was performed on 143 non-diabetic patients who had tested positive for SARS-CoV-2 infection by a PCR test and were hospitalized in our hospital between January 2020 and December 2022. The clinical and para-clinical data at 0, 4, and 12 months of hospital admission for post-COVID-19 infection follow-up was collected and labeled as t0, t4, and t12. Blood glucose, insulin, and C-peptide levels were measured at the beginning and further at 2, 5, 10, and 30 min after the intravenous arginine stimulation test. Similarly, BMI was calculated, and hs-CRP and ESR levels were noted. The results obtained were statistically analyzed. Results: More than one-third (30.7%) of the included patients developed long COVID-19 syndrome. It was found that 75% of patients with long COVID-19 hospitalized in our clinic developed diabetes within a year of acute infection with COVID-19; therefore, it can be said that the presence of long COVID-19 is a major risk for an altered metabolic status, which can cause diabetes. When comparing the glycemia levels (106 mg/dL) with the BMI at t0, t4, and t12 time intervals, the p-values were found to be 0.214, 0.042, and 0.058, respectively. Almost 62% of the patients having BMI > 30 kg/m2 were found to have an increase in blood glucose levels at 1 year. Similarly, insulin resistance was noted during this interval. A negative correlation of 0.40 for hsCRP and 0.38 for ESR was noted when compared with acute infection with COVID-19. Conclusions: The association between long COVID-19 and insulin resistance highlights the varied and widespread impacts of SARS-CoV-2 infection. Addressing the complexities of long COVID-19 requires a holistic strategy that encompasses both respiratory and metabolic considerations, which is crucial for enhancing the well-being of those enduring this persistent condition. [ABSTRACT FROM AUTHOR]

Background: The quantitative interpretation of the radiometric information extracted from infrared (IR) images in individuals with and without type 2 diabetes mellitus (DM2) is an open problem yet to be solved. This is of particular value given that DM2 is a worldwide health problem and onset for evolution toward diabetic foot disease (DFD). Since DM2 causes changes at the vascular and neurological levels, the metabolic heat distribution on the outer skin is modified as a consequence of such alterations. Of particular interest in this contribution are those alterations displayed over the skin's heat patterns at the lower limbs. At the core of such alterations is the deterioration of the vascular and neurological networks responsible for procuring systemic thermoregulation. It is within this context that IR imaging is introduced as a likely aiding tool to assist with the clinical diagnosis of DM2 at stages early enough to prevent the evolution of the DFD. Methods: IR images of lower limbs are acquired from a cohort of individuals clinically diagnosed with and without DM2. Additional inclusion criteria for patients are to be free from any visible wound or tissue‐related trauma (e.g., injuries, edema, and so forth), and also free from non‐metabolic comorbidities. All images and data are equally processed and analyzed using indices that evaluate the spatial and temporal evolution of temperature distribution in lower limbs. We studied the temporal response of individuals' legs after inducing an external stimulus. For this purpose, we combine the information of the asymmetry and thermal response index (ATR) and the thermal response index (TRI), computed using images at different times, improving the results previously obtained individually with ATR and TRI. Results: A novel representation of the information extracted from IR images of the lower limbs in individuals with and without DM2 is presented. This representation was built using the ATR and TRI indices for the anterior and posterior views (PVs), individually and combining the information from both views. In all cases, the information of each index and each view presents linearity properties that allow said information to be interpreted quantitatively in a well‐defined and limited space. This representation, built in a polar coordinate space, allows obtaining sensitivity values of 86%, 97%, and 97%, and specificity values of 83%, 72%, and 78% for the anterior view (AV), the PV, and the combined views, respectively. Additionally, it was observed that the angular variable that defines this new representation space allows to significantly (p < 0.01) differentiate the groups, while correlating with clinical variables of interest, such as glucose and glycated hemoglobin. Conclusion: The linearity properties that exist between the ATR and TRI indices allow a quantitative interpretation of the information extracted from IR images of the lower extremities of individuals with and without DM2, and allow the construction of a representation space that eliminates possible ambiguities in the interpretation, while simplifying it, making it accessible for clinical use. [ABSTRACT FROM AUTHOR]

Angiotensin-converting enzyme 2 (ACE2) is considered a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) receptor of high importance, but due to its non-ubiquitous expression, studies of other proteins that may participate in virus internalisation have been undertaken. To date, many alternative receptors have been discovered. Their functioning may provide an explanation for some of the events observed in severe COVID-19 that cannot be directly explained by the model in which ACE2 constitutes the central point of infection. Diabetes mellitus type 2 (T2D) can induce severe COVID-19 development. Although many mechanisms associated with ACE2 can lead to increased SARS-CoV-2 virulence in diabetes, proteins such as basigin (CD147), glucose-regulated protein 78 kDa (GRP78), cluster of differentiation 4 (CD4), transferrin receptor (TfR), integrins α5β1/αvβ3, or ACE2 co-receptors neuropilin 2 (NRP2), vimentin, and even syalilated gangliosides may also be responsible for worsening the COVID-19 course. On the other hand, some others may play protective roles. Understanding how diabetes-associated mechanisms can induce severe COVID-19 via modification of virus receptor functioning needs further extensive studies. [ABSTRACT FROM AUTHOR]

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This study aimed to assess the diagnosis of diabetes after detecting high blood glucose levels through screening among insured individuals in Gunma, Japan. Data for men and women 35 to 74 years of age were provided by Japan Health Insurance Association, and 4133 individuals with high blood glucose levels while not currently being treated for diabetes were included in the study. About 13% received a diagnosis of diabetes at a subsequent physician visit, and individuals who were under treatment for hypertension were less likely to receive the added diagnosis of diabetes compared with those not being treated for hypertension (odds ratio = 0.42 from a logistic regression model). Fasting blood glucose levels were significantly improved in the next year only among individuals with a confirmed diagnosis of diabetes. [ABSTRACT FROM AUTHOR]

The aim of the work was to investigate the dynamics of endothelial markers in patients with arterial hypertension with different cardiovascular risk under the influence of the prescribed treatment during a year of observation. The first group (with a moderate risk of cardiovascular events) included 48 patients with arterial hypertension (AH). The second group consisted of 54 patients with hypertension and a high risk of cardiovascular events, namely type 2 diabetes. Each group of patients was randomized into two subgroups by blood pressure (BP) medication. In patients of subgroup 1a (n=29) and subgroup 2a (n=35) – the main subgroups – the therapy necessarily included the angiotensin II receptor antagonist losartan potas­sium in a dosage of 50-150 mg/day, depending on the blood pressure level. Patients of subgroup 1b (n=19) and subgroup 2b (n=19) – comparison subgroups were treated with antihypertensive drugs of other first-line groups according to the data of the unified clinical protocol for the treatment of hypertension. According to the ROC analysis, it was determined that the dynamics of endothelin-1 (ET-1) indicators after 9 and 12 months of therapy (a decrease of 12% or more from the initial level) can predict the normalization of indicators of the coagulation and anticoagulation systems with indicators of sensitivity and specificity – 85% (95% CI 62.1-96.6%) and 92.9% (95% CI 76.5-98.9%), respectively. A decrease in the level of Willebrand factor (fV) by 23% or more due to such a treatment time can be used as a prognostic sign in determining the regression of endothelial dysfunction with sensitivity – 75% (95% CI 50.9-91.2%), specificity – 100% (95% CI 87.5-100%). According to the given data, both in the group with moderate and with high cardiovascular risk, there is a relationship between endothelial dysfunction (ED) and the duration of hypertension, indicators of the lipid spectrum and abdominal obesity – factors that increase the viscous resistance of the blood circulation, as well as platelet hyperactivity in the bloodstream. We have also established that according to the dynamics of ET-1 indicators after 9 and 12 months of therapy (decrease by 27% or more from the initial level), it is possible to predict the normalization of indicators of the coagulation and anticoagulation systems with indicators of sensitivity – 81.8% (95% CI 59.7-94.7%), specificity – 90.6% (95% CI 75-97.9%). A decrease in the level of fV by 24.5% or more after a year of treatment can be used as a prognostic sign in determining the regression of endothelial dysfunction with sensitivity – 68.2% (95% CI 45.1-86.1%), specificity – 71.9% (95% CI 53.3-86.2%). The obtained results testify to the dominant role of type 2 diabetes as a factor in platelet disorders of hemostasis. Taking into account the positive dynamics of the above-mentioned markers of ED during the year of treatment, their relationship with the reduction of blood pressure, indicators of the lipid spectrum and abdominal obesity, it should be noted the positive effect of angiotensin II receptor blockers (BRA II) as endothelioprotective drugs. Considering the irrefutable literary data about the absence of thrombomodulin in the blood stream, even its insignificant appearance indicates the presence of endothelial dysfunction. Determining the state and dynamics of changes in endothelial function under the influence of prescribed therapy will make it possible to improve the diagnosis of endothelial function disorders and increase the effectiveness of treatment of patients with hypertension and various cardiovascular risks.

Diabetic kidney disease (DKD) is the leading cause of end-stage renal failure. Evidence indicates gender differences in the progression of this disease. This study aimed to determine gender differences in prevalence and identify gender-associated risk factors contributing to the development of diabetic kidney disease in individuals with type 2 diabetes mellitus (T2DM). The cross-sectional study included 132 patients with T2DM ranging in age from 50 to 65 years. Subjects were stratified by sex (80 women and 52 men). Gender differences have been studied in relation to the incidence and prevalence of DKD, their phenotypes and clinical manifestations, and several risk factors that have different effects on both sexes. The outcome of clinical kidney function assessment showed that 70% subjects were diagnosed with DKD (71% of women and 67% of men). The study indicated an association between the duration of T2DM and urinary albumin levels, as well as between arterial hypertension and triglyceride levels, which are independent risk factors for DKD development. Notably, older women with T2DM have a higher prevalence of DKD than older men. The albuminuric component of DKD was more frequently observed in men. Additionally, men were more likely to have adverse risk factors, including dyslipidemia, lower high-density lipoprotein cholesterol, and glomerular filtration rate, which are factors involved in the mechanisms of DKD. In summary, the results indicate that: 1) women with type 2 diabetes mellitus are at a higher risk of developing a normoalbuminuric phenotype of diabetic kidney disease, while men are at a higher risk of developing an albuminuric phenotype of diabetic kidney disease leading to renal failure and end-stage renal disease; 2) gender differences are most noticeable among older adults and may have significant implications for the development of more effective diagnostic and treatment methods for diabetic kidney disease, tailored to individual needs.

Cholesterol is a fat component that stabilizes cell membranes and is a precursor of bile salts and steroid hormones. The HMG-CoA reductase enzyme has an important role in the cholesterol synthesis process. Triglycerides are the primary fats found in food that undergo emulsification in the small intestine by bile salts and are digested by lipase. The flavonoids in bay leaves will react with the hydroxyl groups in cholesterol. Saponins will increase the binding of cholesterol to fiber. Tannins can inhibit fat absorption in the intestine. This study examined the effect of administering bay leaf extract (Eugenia polyantha) on total cholesterol and triglyceride levels in patients with hypertension and Diabetes mellitus type 2 in Clinic Iman Medan. This research is a Quasi-experimental design using 32 samples consisting of 16 samples from the control group and 16 from the experimental group. This study used bay leaf extract in 200 mg bay leaf capsules with 3 doses given to each group. Based on the results of the hypothesis test using the Paired T-test and Wilcoxon test, giving bay leaf extract had no effect on total cholesterol and triglyceride levels with a P-value < 0.05. There was no effect of giving bay leaf extract (Eugenia polyantha) on total cholesterol and triglyceride levels in patients with hypertension and DM type 2

Background: Lifestyle medicine (LM) is a contemporary scientific discipline with a multidisciplinary approach. Case Management offers a viable alternative for the care of patients with Type 2 Diabetes (T2D). This study aimed to identify the role and clinical applications of the lifestyle medicine case manager nurse (LMCMN) for T2D patients internationally and to analyze the role of specialist nurses in Italy through a narrative review. A secondary objective was to define a job description (JD) for a future Delphi method. Methods: A narrative review of the literature was conducted using PubMed/Medline, Scopus, and grey literature sources to analyze the international and Italian regulatory contexts. Subsequently, a JD for the LMCMN was developed for application in a future Delphi Study. Results: Nurses play a strategic role in managing T2D, and the LM approach has demonstrated strong evidence of effectiveness. This study developed a specific JD for the LMCMN suitable for both Italian and international contexts. Conclusions: The specific role of the LMCMN is still underdeveloped internationally. In the context of territorial assistance and chronic disease management, this professional is crucial for delivering quality care and shaping health policies that meet community needs.

Abstract Background The weight-adjusted waist index (WWI) is a quantitative anthropometric index that can be applied to evaluate obesity. This study examined the relationship between adult United States (US) residents’ risk of diabetes mellitus type 2 (T2DM) and WWI. Methods The NHANES (National Health and Nutrition Examination Survey) 2001–2018 provided the data for this investigation. This study used multifactorial logistic regression analysis, smoothed curve fitting, subgroup analysis, and interaction tests to assess the association between WWI and T2DM. Additionally, threshold effects were calculated using a two-stage linear regression model. The receiver operating characteristic(ROC) curves evaluated the diagnostic ability of the WWI and commonly used obesity indicators. Results 20,477 participants were enrolled in the analysis, and patients with greater levels of WWI had a higher prevalence of T2DM. WWI and T2DM have a non-linear relationship, with a positive association found on the left side of the breakpoint (WWI = 12.35) (OR = 1.82, 95%CI:1.64–2.02), whereas, on the right side, no such relationship was found (OR = 0.9, 95%CI:0.61–1.34). For every unit rise in WWI, the probability of having T2DM increased by 67% after controlling for all other variables (OR:1.67,95%CI:1.53–1.83). Based on subgroup analyses, individuals under 40 had a higher correlation between WWI and T2DM (P

Abstract Background Bladder cancer (BC) and Renal cell carcinoma (RCC) are the most common urogenital cancers among both sexes, with a yearly global incidence of around 500 000 each. Both BC and RCC have been linked to diabetes. Poor glycemic control (malglycemia) is a serious consequence of diabetes and a possible consequence of systemic treatments used in BC and RCC. The objective of this study was to investigate the prevalence of diabetes and use of hospital-based care for malglycemia in people with BC or RCC. Methods This Swedish retrospective population-based register study used national health-data registers for longitudinal data on cancer incidence covering 15 years, use of hospital-based health care, and filled prescriptions of outpatient medications. Study endpoints included co-prevalence of diabetes in individuals with BC/RCC, healthcare resource utilization due to malglycemia, use of systemic corticosteroids, and changes in diabetes management for people with concomitant type 2 diabetes. Results We identified 36,620 and 15,581 individuals diagnosed with BC and RCC, respectively, between 2006 and 2019. The proportion of individuals registered with diabetes was 24% in BC and 23% in RCC. An association between BC/RCC and poor glycemic control was found, although the number of malglycemic events in hospital-based care were few (65/59 per 1000 individuals with diabetes and BC/RCC respectively with at least one event). An earlier switch to insulin-based diabetes management was observed in BC/RCC compared to matched individuals with type 2 diabetes but no cancer. The results also indicated an association between steroid treatment and poor glycemic control, and that systemic corticosteroids were more common among people with BC/RCC compared to diabetes controls. Conclusion The high prevalence of diabetes and increased use of systemic corticosteroid treatment observed in this large national study highlights the need for specific clinical management, risk-assessment, and monitoring of individuals with BC/RCC and diabetes.

Objective To explore the roles of serum tissue inhibitor of matrix metalloproteinase 3（TIMP3） and sex determining region Y box protein 2（SOX2） in an early diagnosis of renal injury in type 2 diabetes mellitus（T2DM）. Methods From April 2022 to April 2023， 102 T2DM patients visiting General Hospital of North China Petroleum Administration Bureau were recruited as research subjects. Based upon 24 h serum urinary protein excretion rate（UAER）， they were assigned into two groups of renal injury（n = 40） and renal non-injury（n = 62）. Another 50 patients undergoing health examinations at General Hospital of North China Petroleum Administration Bureau were regarded as control group. Enzyme-linked immunosorbent assay（ELISA） was utilized for measuring the serum levels of TIMP3 and SOX2. General profiles， serum levels of TIMP3， SOX2， glycosylated hemoglobin（HbA1c）， UAER， serum creatinine（Scr） and glomerular filtration rate（eGFR） of three groups were compared. Pearson’s correlation was utilized for examining the relationship between serum TIMP3/SOX2 and HbA1c， UAER， Scr and eGFR. Receiver operating characteristic curve（ROC） was applied for examining the diagnostic value of serum TIMP3/SOX2 for renal injury in T2DM patients. Results The serum levels of TIMP3 [（0.68 ± 0.17）μg/L vs （1.35 ± 0.35）μg/L] and eGFR [（105.99 ± 20.56）mL·min−1·（1.73 m2）−1 vs （133.15 ± 26.18）mL·min−1·（1.73 m2）−1] were obviously lower in T2DM patients than those in control group（P＜0.05）. Serum levels of TIMP3 [（0.47 ± 0.11）μg/L vs （0.82 ± 0.21）μg/L] and eGFR [（74.69 ± 10.22）mL·min−1·（1.73 m2）−1 vs （126.18 ± 27.23）mL·min−1·（1.73 m2）−1] were obviously lower in patients with renal injury than those without（P＜0.05）. Serum levels of SOX2 [（8.91 ± 1.82）kU/L vs （5.15 ± 1.31）kU/L]， HbA1c[（8.80 ± 1.55）% vs （5.52 ± 0.83）%]， UAER [（70.13 ± 18.06）mg/24 h vs （13.22 ± 3.61）mg/24 h] and Scr [（82.14 ± 15.23）µmol/L vs （53.19 ± 5.62）µmol/L] were obviously higher than those in control group（P＜0.05）. Serum levels of SOX2 [（10.81 ± 2.13）kU/L vs （5.15 ± 1.31）kU/L]， UAER [（156.83 ± 40.29）mg/24 h vs （13.22 ± 3.61）mg/24 h] and Scr [（113.77 ± 13.58）µmol/L vs （53.19 ± 5.62）µmol/L] were obviously higher in patients with renal injury than in patients without（P＜0.05）. Pearson’s correlation analysis revealed that TIMP3 was obviously correlated negatively with HbA1c， UAER and Scr（P＜0.05） and positively with eGFR（P＜0.05）. SOX2 was obviously correlated positively with HbA1c， UAER and Scr（P＜0.05） and negatively with eGFR（P＜0.05）. An obvious negative correlation existed between serum TIMP3 and SOX2（r = −0.590，P＜0.05）. The results of ROC indicated that the sensitivity and specificity of serum TIMP3 plus SOX2 in the diagnosis of renal injury in T2DM patients were 95.0% and 85.3% respectively. Both were obviously higher than those of TIMP3 and SOX2 alone. Conclusions Serum levels of TIMP3 and SOX2 decline markedly and the two are closely correlated with renal injury in T2DM patients. Both may be used for an early diagnosis of renal injury in T2DM patients.

Background: Coronary Heart Disease (CHD) is a disease caused by the narrowing of the coronary artery wall as a result of the atherosclerosis process. Atherosclerosis plays an important role from the beginning of plaque formation until plaque rupture which causes blood clots. Diabetes mellitus and dyslipidemia are one of the major risk factors for CHD. In patients with type 2 Diabetes Mellitus, there was an altered lipid profile which led to endothelial damage that caused the formation of atherosclerosis. HDL cholesterol labeled as good cholesterol was decreased due to uncontrolled LDL cholesterol labeled as bad cholesterol. LDL cholesterol synthesis process was disrupted then causing plaque formation in the arteries which causes CHD. Aim: The aim of this study was to analysis correlation between HbA1c levels, triglyceride levels, HDL levels and the degree of stenosis in coronary heart disease sufferers with type 2 diabetes mellitus. Method: This study was an observational cross-sectional analytical study with total of 51 patients with CHD who underwent cardiac catheterization at Telogorejo Hospital. Semarang. The correlation test in this study using the Spearman test with p

Background and Objective: Lack of sleep and insomnia are associated with an increase in the risk of diabetes. Sleep disorders in diabetic people are significantly higher than in healthy people. Moreover, sleep duration is related to blood sugar control in diabetes. This study was conducted with the purpose of investigating the level of sleepiness and obstructive sleep apnea in type 2 diabetic patients and its relationship with glycemic levels. Materials and Methods: This cross-sectional study was conducted on 200 patients with type 2 diabetes referred to Shahid Beheshti Hospital in Hamadan in­ 2023­. Diabetes control status was evaluated by hemoglobin A1c, and the frequency of sleepiness and obstructive sleep apnea was assessed by the Epworth Sleepiness Scale and STOP-BANG questionnaires. Data analysis was done using SPSS 26 statistical software. Results: The mean age of the participants was 56.16 ± 9.77 years. A significant difference was observed between the frequency of daily sleepiness score with gender (P

Abstract Background Measuring treatment burden is important for the effective management of Type 2 Diabetes Mellitus (T2DM) care. The purpose of this systematic review was to identify the most robust approach for measuring treatment burden in people with T2DM based on existing evidence. Methods Articles from seven databases were retrieved. Qualitative, quantitative, and mixed-methods studies examining treatment burden in adults with T2DM and/or reporting relevant experiences were included. A convergent segregated approach with a mixed-methods design of systematic review was employed, creating a measurement framework in a narrative review for consistent critical appraisal. The quality of included studies was assessed using the Joanna Briggs Institute tool. The measurement properties of the instruments were evaluated using the Consensus based Standards for selection of Health Measurement Instruments (COSMIN) checklist. Results A total of 21,584 records were screened, and 26 articles were included, comprising 11 quantitative, 11 qualitative, and 4 mixed-methods studies. A thematic analysis of qualitative data extracted from the included articles summarised a measurement framework encompassing seven core and six associated measurements. The core measurements, including financial, medication, administrative, lifestyle, healthcare, time/travel, and medical information burdens, directly reflect the constructs pertinent to the treatment burden of T2DM. In contrast, the associated measurement themes do not directly reflect the burdens or are less substantiated by current evidence. The results of the COSMIN checklist evaluation demonstrated that the Patient Experience with Treatment and Self-management (PETS), Treatment Burden Questionnaire (TBQ), and Multimorbidity Treatment Burden Questionnaire (MTBQ) have robust instrument development processes. These three instruments, with the highest total counts combining the number of themes covered and "positive" ratings in COSMIN evaluation, were in the top tertile stratification, demonstrating superior applicability for measuring T2DM treatment burden. Conclusions This systematic review provides evidence for the currently superior option of measuring treatment burden in people with T2DM. It also revealed that most current research was conducted in well-resourced institutions, potentially overlooking variability in under-resourced settings.

Issues Addressed Methods Results Conclusions So What? Addressing the disproportionate burden of type 2 diabetes prevalence in Aboriginal communities is critical. Current literature on diabetes care for Aboriginal people is primarily focused on remote demographics and overwhelmingly dominated by Western biomedical models and deficit paradigms. This qualitative research project adopted a strengths‐based approach to explore the barriers and enablers to diabetes care for Aboriginal people on Ngarrindjeri Country in rural South Australia.Knowledge Interface methodology guided the research as Aboriginal and Western research methods were drawn upon. Data collection occurred using three yarning sessions held on Ngarrindjeri Country. Yarns were transcribed and deidentified before a qualitative thematic analysis was conducted, guided by Dadirri and a constructivist approach to grounded theory.A total of 15 participants attended the yarns. Major barriers identified by participants were underscored by the ongoing impacts of colonisation. This was combated by a current of survival as participants identified enablers to diabetes care, namely a history of healthy community, working at the knowledge interface, motivators for action, and an abundance of community skills and leadership.Despite the raft of barriers detailed by participants throughout the diabetes care journey, Aboriginal people on Ngarrindjeri Country were found to be uniquely positioned to address diabetes prevalence and management.Health promotion efforts with Aboriginal people on Ngarrindjeri Country must acknowledge the sustained impacts of colonisation, while building on the abundance of community enablers, skills and strengths. Opportunities present to do so by adopting holistic, community‐led initiatives that shift away from the dominant biomedical approach to diabetes care. [ABSTRACT FROM AUTHOR]

This study aimed to assess the burden of type 2 diabetes mellitus (T2DM) in Latin America. An ecological study design was applied. The data on T2DM (i.e. incidence, mortality, disability-adjusted life years [DALYs], years lived with disability [YLDs] and years of life lost [YLLs]) were extracted from the Global Burden Disease 2019 study. To assess the trends, the average annual percentage change was computed using the joinpoint regression analysis. Approximately 2.3 million new cases of T2DM were diagnosed in Latin America in 2019, with about 214,000 deaths. The age-standardised rates of T2DM burden in 2019 were highest in Central Latin America. Incidence of T2DM has increased in both males and females in Latin America over the last three decades, while mortality has increased only in males. Of particular concern are the significant increasing trends in the incidence of T2DM among individuals in the young age and middle age groups (15–64 years) in both men and in women. Increasing trends in the burden of T2DM were observed in almost all countries of Andean Latin America, the Caribbean and Central Latin America (in particular, in Guatemala, where T2DM incidence increased by 2.4% per year, mortality by 3.7%, DALYs by 3.4%, YLDs by 2.7% and YLLs by 3.8%). T2DM is an important health issue in Latin America due to the high mortality and disability burdens and the impact on life expectancy and quality of life of the population. Unfavourable trends in T2DM burden highlight the need to introduce effective public health disease management strategies. [ABSTRACT FROM AUTHOR]

The American Diabetes Association (ADA) guidelines prioritize Sodicum-glucose transporter-2-inhibitors (SGLT2i) given cardio-renal and glycemic benefits. This study was conducted to observe clinical factors associated with initial SGLT2i prescription in type 2 diabetes patients eligible for SGLT2i by the ADA. Methods. A retrospective case-control study was performed in a safety-net clinic and consisted of the initial SGLT2i prescriptions group and the group without. The data from the electronic medical records between July 2021 and December 2022 were analyzed in the regressional models. Results. There was a significant association between A1c ≥8% (OR 3.7, p=.01), heart failure (OR 19.3, p<.0001), a history of hypotension (OR 11.9, p=.01), and sulfonylureas (OR 6.5, p=.003) with the SGLT2i prescription. Conclusion. Patients with high A1c levels, heart failure, a history of hypotension, and sulfonylureas were more likely than their counterparts to receive SGLT2i prescriptions. Future research should investigate adherence and provider prescribing behaviors related to SGLT2i to further assess optimal drug use. [ABSTRACT FROM AUTHOR]

Introduction: For people with type 2 diabetes and/or cardiovascular conditions, deprescribing of glucose-lowering, blood pressure-lowering and/or lipid-lowering medication is recommended when they age, and their health status deteriorates. So far, deprescribing rates of these so-called cardiometabolic medications are low. A review of challenges and interventions addressing these challenges in this population is pertinent. Areas covered: We first provide an overview of relevant deprescribing recommendations. Next, we review challenges for healthcare providers (HCPs) to deprescribe cardiometabolic medication and provide insight in the patient and caregiver perspective on deprescribing. We summarize findings from research on implementing deprescribing of cardiometabolic medication and reflect on strategies to enhance deprescribing. We have used a combination of methods to search for relevant articles. Expert opinion: There is a need for rigorous development and evaluation of intervention strategies aimed at proactive deprescribing of cardiometabolic medication. To address challenges at different levels, these should be multifaceted interventions. All stakeholders must become aware of the relevance of deintensifying medication in this population. Education and training for HCPs and patients should support patient-centered communication and shared decision-making. Development of procedures and tools to select eligible patients and conduct targeted medication reviews are important for implementation of deprescribing in routine care. [ABSTRACT FROM AUTHOR]

Background: The weight-adjusted waist index (WWI) is a quantitative anthropometric index that can be applied to evaluate obesity. This study examined the relationship between adult United States (US) residents' risk of diabetes mellitus type 2 (T2DM) and WWI. Methods: The NHANES (National Health and Nutrition Examination Survey) 2001–2018 provided the data for this investigation. This study used multifactorial logistic regression analysis, smoothed curve fitting, subgroup analysis, and interaction tests to assess the association between WWI and T2DM. Additionally, threshold effects were calculated using a two-stage linear regression model. The receiver operating characteristic(ROC) curves evaluated the diagnostic ability of the WWI and commonly used obesity indicators. Results: 20,477 participants were enrolled in the analysis, and patients with greater levels of WWI had a higher prevalence of T2DM. WWI and T2DM have a non-linear relationship, with a positive association found on the left side of the breakpoint (WWI = 12.35) (OR = 1.82, 95%CI:1.64–2.02), whereas, on the right side, no such relationship was found (OR = 0.9, 95%CI:0.61–1.34). For every unit rise in WWI, the probability of having T2DM increased by 67% after controlling for all other variables (OR:1.67,95%CI:1.53–1.83). Based on subgroup analyses, individuals under 40 had a higher correlation between WWI and T2DM (P < 0.001).ROC analyses showed that WWI had the best discrimination and accuracy in predicting T2DM compared to other obesity indicators (WC, BMI, and Weight). Conclusion: Higher WWI values had a higher prevalence of T2DM in US individuals, especially in adults under 40. WWI has the strongest ability to predict T2DM. Therefore, the importance of WWI in the early identification of T2DM in US adults should be emphasized. [ABSTRACT FROM AUTHOR]

Background: Bladder cancer (BC) and Renal cell carcinoma (RCC) are the most common urogenital cancers among both sexes, with a yearly global incidence of around 500 000 each. Both BC and RCC have been linked to diabetes. Poor glycemic control (malglycemia) is a serious consequence of diabetes and a possible consequence of systemic treatments used in BC and RCC. The objective of this study was to investigate the prevalence of diabetes and use of hospital-based care for malglycemia in people with BC or RCC. Methods: This Swedish retrospective population-based register study used national health-data registers for longitudinal data on cancer incidence covering 15 years, use of hospital-based health care, and filled prescriptions of outpatient medications. Study endpoints included co-prevalence of diabetes in individuals with BC/RCC, healthcare resource utilization due to malglycemia, use of systemic corticosteroids, and changes in diabetes management for people with concomitant type 2 diabetes. Results: We identified 36,620 and 15,581 individuals diagnosed with BC and RCC, respectively, between 2006 and 2019. The proportion of individuals registered with diabetes was 24% in BC and 23% in RCC. An association between BC/RCC and poor glycemic control was found, although the number of malglycemic events in hospital-based care were few (65/59 per 1000 individuals with diabetes and BC/RCC respectively with at least one event). An earlier switch to insulin-based diabetes management was observed in BC/RCC compared to matched individuals with type 2 diabetes but no cancer. The results also indicated an association between steroid treatment and poor glycemic control, and that systemic corticosteroids were more common among people with BC/RCC compared to diabetes controls. Conclusion: The high prevalence of diabetes and increased use of systemic corticosteroid treatment observed in this large national study highlights the need for specific clinical management, risk-assessment, and monitoring of individuals with BC/RCC and diabetes. [ABSTRACT FROM AUTHOR]

Introduction: Diabetes, as one of the common causes of mortality worldwide, extends beyond physical aspects and can impact psychological and emotional dimensions as well. Therefore, the present research aimed to determine the effectiveness of spiritual therapy on the psychological well -being and self-efficacy of patients with type 2 diabetes in Tehran. Methods: This study was a semi -experimental research with a pretest -posttest and a three -month follow -up design with a control group. The study population consisted of all the patients with type 2 diabetes who attended treatment centers in Tehran (Masih Daneshvari, Nikan, and the Iranian Diabetes Association) from August to November 2023. Among the patients, 37 were selected using purposive sampling and were randomly assigned to two groups: the experimental group (N=18) and the control group (N=19). The data collection tools included a demographic information form, the standardized Ryff's scale of psychological well -being – short form (Cronbach's alpha= 0 /72), and the General Self-Efficacy Scale (Cronbach's alpha= 0 /83). Data analysis was conducted using SPSS -21 software. Additionally, given the different stages of measurement (pre -test, post -test, and follow -up), repeated measures ANOVA was used for data analysis. Results: The results indicated that spiritual therapy led to an increase in psychological well -being (F=132 /56, P<0 /001) and self-efficacy (F=15 /51, P<0 /001) in patients with type 2 diabetes. Furthermore, the effect size of spiritual therapy on psychological well -being was 79%, and self-efficacy was 31%, and the sustainability of its effects was observed up to three months after treatment. Conclusion: The findings suggest the impact of spiritual therapy on enhancing psychological well -being and self-efficacy in patients with type 2 diabetes. Therefore, it is recommended that, in addition to the routine treatment of patients with type 2 diabetes, spiritual therapy be utilized to enhance the psychological well - being of the patients [ABSTRACT FROM AUTHOR]

Introduction: vitamin D is a steroid hormone that has important roles in the homeostasis of the human body, and one of them is the stimulation of insulin secretion from the pancreas. Therefore, the aim of this study is to examine the association between vitamin D deficiency and type 1 and type 2 diabetes mellitus. Materials and methods: 60 patients with diabetes mellitus type 1 (DMT1) and 60 patients with diabetes mellitus type 2 (DMT2) were included in the study and two control groups of 60 patients each. Gender, age, HbA1c and vitamin D concentration were compared between these two groups. The association between vitamin D deficiency and type 1 and type 2 diabetes mellitus was examined by comparing vitamin D values in patients with DMT1 and DMT2 and control groups. Results: the group of patients with DMT2 consisted of significantly older people and female patients (p<0.001). The concentration of HbA1c is significantly higher in patients with DMT2 (p<0.001). Vitamin D concentration was significantly higher in patients with DMT1 (p<0.001). An association between DMT1 and DMT2 and vitamin D deficiency was observed (p<0.001). Conclusion: the conducted study proved vitamin D deficiency in patients with DMT1 and DMT2 and serves as a valuable indicator in the further treatment of these patients. [ABSTRACT FROM AUTHOR]

Background: This study aimed to develop a diabetic kidney disease (DKD) prediction model using long short term memory (LSTM) neural network and evaluate its performance using accuracy, precision, recall, and area under the curve (AUC) of the receiver operating characteristic (ROC) curve. Methods: The study identified DKD risk factors through literature review and physician focus group, and collected 7 years of data from 6,040 type 2 diabetes mellitus patients based on the risk factors. Pytorch was used to build the LSTM neural network, with 70% of the data used for training and the other 30% for testing. Three models were established to examine the impact of glycosylated hemoglobin (HbA1c), systolic blood pressure (SBP), and pulse pressure (PP) variabilities on the model’s performance. Results: The developed model achieved an accuracy of 83% and an AUC of 0.83. When the risk factor of HbA1c variability, SBP variability, or PP variability was removed one by one, the accuracy of each model was significantly lower than that of the optimal model, with an accuracy of 78% (P<0.001), 79% (P<0.001), and 81% (P<0.001), respectively. The AUC of ROC was also significantly lower for each model, with values of 0.72 (P<0.001), 0.75 (P<0.001), and 0.77 (P<0.05). Conclusion: The developed DKD risk predictive model using LSTM neural networks demonstrated high accuracy and AUC value. When HbA1c, SBP, and PP variabilities were added to the model as featured characteristics, the model’s performance was greatly improved. [ABSTRACT FROM AUTHOR]

Background: Melatonin, mainly regulating the body's circadian rhythm, may have protective effects against type 2 diabetes mellitus (DM2)-induced depression due to its antioxidant and regulatory impact in the pathogenesis of both DM2 and depression. This study aimed to find the association of serum melatonin levels with depression in DM2 patients. Methods: A total of 50 DM2 patients were recruited in this retrospective cross-sectional study and divided into 25 patients with depression (DM2-DP) and 25 without depression symptoms (DM2-NDP). Depression was diagnosed using the Hospital Anxiety and Depression Scale (HADS) assessment. Fasting blood samples were collected and examined for the level of serum melatonin and other biomarkers. All statistical analysis was performed by SPSS software Version 22, and a p-value less than 0.05 was considered statistically significant for all tests. Results: The depression score was significantly lower in DM2-NDP than DM2-DP (p< 0.001). The mean weight was significantly lower in the DM2-DP group (P= 0.021). Total cholesterol, triglyceride, and anxiety scores were higher, and the melatonin level was lower in DM2-DP. The correlation of melatonin levels was positive with age, DBP, HbA1C, FBS, and TG. In contrast, it was negative with male gender, BMI, diabetes duration, SBP, TC, family history of DM, depression score, and anxiety score. However, no significant differences were seen. Conclusion: Lower melatonin may be associated with depression and anxiety in patients with DM2. The serum melatonin level might be a strong predictor of depression in DM2 patients. [ABSTRACT FROM AUTHOR]

Background: Measuring treatment burden is important for the effective management of Type 2 Diabetes Mellitus (T2DM) care. The purpose of this systematic review was to identify the most robust approach for measuring treatment burden in people with T2DM based on existing evidence. Methods: Articles from seven databases were retrieved. Qualitative, quantitative, and mixed-methods studies examining treatment burden in adults with T2DM and/or reporting relevant experiences were included. A convergent segregated approach with a mixed-methods design of systematic review was employed, creating a measurement framework in a narrative review for consistent critical appraisal. The quality of included studies was assessed using the Joanna Briggs Institute tool. The measurement properties of the instruments were evaluated using the Consensus based Standards for selection of Health Measurement Instruments (COSMIN) checklist. Results: A total of 21,584 records were screened, and 26 articles were included, comprising 11 quantitative, 11 qualitative, and 4 mixed-methods studies. A thematic analysis of qualitative data extracted from the included articles summarised a measurement framework encompassing seven core and six associated measurements. The core measurements, including financial, medication, administrative, lifestyle, healthcare, time/travel, and medical information burdens, directly reflect the constructs pertinent to the treatment burden of T2DM. In contrast, the associated measurement themes do not directly reflect the burdens or are less substantiated by current evidence. The results of the COSMIN checklist evaluation demonstrated that the Patient Experience with Treatment and Self-management (PETS), Treatment Burden Questionnaire (TBQ), and Multimorbidity Treatment Burden Questionnaire (MTBQ) have robust instrument development processes. These three instruments, with the highest total counts combining the number of themes covered and "positive" ratings in COSMIN evaluation, were in the top tertile stratification, demonstrating superior applicability for measuring T2DM treatment burden. Conclusions: This systematic review provides evidence for the currently superior option of measuring treatment burden in people with T2DM. It also revealed that most current research was conducted in well-resourced institutions, potentially overlooking variability in under-resourced settings. [ABSTRACT FROM AUTHOR]

Glucagon-like peptide-1 (GLP-1) is an incretin hormone secreted by food intake from L cells of the ileum. GLP-1 contributes to blood glucose control through three main mechanisms: promoting glucose-dependent insulin secretion from pancreatic beta cells, suppressing glucagon hypersecretion from pancreatic alpha cells, and delaying gastric emptying time. GLP-1 receptor agonists (RAs) have been developed for administration twice daily, once daily, and once weekly as subcutaneous injection formulation and as a daily oral formulation. GLP-1 RAs have benefits in reducing glycated hemoglobin, weight, and blood pressure, as well as in managing lipid profiles. Additionally, some GLP-1 RAs have demonstrated cardiovascular benefits. Therefore, the guidelines recommend GLP-1 RA treatment of type 2 diabetes patients with preexisting atherosclerotic vascular disease. GLP-1 RA may also improve renal outcomes. The most frequently reported side effects of GLP-1 RA are gastrointestinal symptoms, which can be minimized by gradually starting treatment at a low concentration and then increasing to the final dosage. Considering the efficacy, administration frequency, and cost of each GLP-1 RA treatment, it can be selected as monotherapy or in combination with oral hypoglycemic agents and basal insulin in free or fixed dose formulation. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to estimate the prevalence of potentially inappropriate prescriptions (PIPs) in patients starting their first noninsulin antidiabetic treatment (NIAD) using two explicit process measures of the appropriateness of prescribing in UK primary care, stratified by age and polypharmacy status. Methods: A descriptive cohort study between 2016 and 2019 was conducted to assess PIPs in patients aged ≥45 years at the start of their first NIAD, stratified by age and polypharmacy status. The American Geriatrics Society Beers criteria 2015 was used for older (≥65 years) patients and the Prescribing Optimally in Middle‐age People's Treatments criteria was used for middle‐aged (45‐64 years) patients. Prevalence of overall PIPs and individual PIPs criteria was reported using the IQVIA Medical Research Data incorporating THIN, a Cegedim Database of anonymized electronic health records in the UK. Results: Among 28 604 patients initiating NIADs, 18 494 (64.7%) received polypharmacy. In older and middle‐aged patients with polypharmacy, 39.6% and 22.7%, respectively, received ≥1 PIP. At the individual PIP level, long‐term proton pump inhibitors (PPI) use was the most frequent PIP among older adults, and strong opioid without laxatives was the most frequent PIP in middle‐aged patients with polypharmacy (11.1% and 4.1%, respectively). Conclusions: This study revealed that patients starting NIAD treatment receiving polypharmacy have the potential for pharmacotherapy optimization. [ABSTRACT FROM AUTHOR]

Introduction: Insulin resistance is a common condition affecting thousands of people worldwide. This paper aims to examine the mechanisms underlying insulin resistance among people suffering from obesity. Methods and Design: This study entailed identifying articles related to insulin resistance and obesity. The publications were obtained using different electronic databases, including PubMed, EBSCO, and LILACS. The search terms included "insulin", "resistance", "obesity", and "mechanisms". Boolean operators were used to combine terms and phrases. Results: Insulin resistance is a physiological condition characterized by the impaired action of insulin in the body. The association between obesity and insulin resistance is linked to inflammatory, neural, and endocrine pathways that affect the sensitivity of organs to the level of insulin in the body. Discussion: Molecular studies have helped discover some of the fundamental mechanisms leading to the development of insulin resistance. Further investigations are needed to enhance our understanding of the connections among the inflammatory, neural, and cellular processes underlying the association between insulin resistance and obesity. Conclusion: This study revealed that a complex correlation exists between insulin resistance and obesity. This relationship involves a wide range of inflammatory, neural, and endocrine processes. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus has become increasingly common worldwide, with many serious complications. Diabetic nephropathy is one such complication that affects the kidney and leads to end-stage renal failure worldwide. Microalbuminuria represents an abnormal elevation in urine albumin levels, which is an early marker of diabetic nephropathy. It is likely to be found in one-third or more of diabetic patients. Early recognition of microalbuminuria in diabetic nephropathy permits successful therapeutic intervention and significant postponement of terminal renal failure. Objective: To investigate the prevalence of microalbuminuria in type 2 diabetes patients attending AL-Thawra Hospital and Saref Medical Centre in Sana'a City. Materials and Methods: This study was carried out in AL-Thawra Hospital and Saref Medical Center in Sana'a City, during the period (from 1 February to 30 April 2021). 125 Type 2 diabetic patients (diagnosed according to American Diabetes Association (ADA) criteria for diagnosis of diabetes) were selected). Medical records were used to collect data on duration of diabetes, gender, age and body mass index (BMI). Microalbuminuria was assessed using mispa-i3 kits in spot of the morning urine samples. Results: The prevalence of microalbuminuria and macroalbuminuria among type 2 diabetic patients was 44.8% and 12 %, respectively. Microalbuminuria had a statistically significant association with longer duration (P = 0.031), and no statistically significant association was found between microalbuminuria and gender (P = 0.419), age (P = 0.299) and body mass index (P = 0.390). Conclusion: The prevalence of microalbuminuria in this study was considerably high (44.8%) in type 2 diabetes. 44.8% (nearly half) of type 2 diabetic patients in this study are at risk of developing kidney disease due to their high microalbuminuria level. This calls for regular and early screening for microalbuminuria is recommended for all diabetic patients, as early treatment is critical for reducing the progression to the late stage of diabetic nephropathy (overt proteinuria and end-stage renal disease). [ABSTRACT FROM AUTHOR]

To assess the willingness of people with type 2 diabetes (T2D) to engage in healthy eating, physical activity and medication taking, and explore associated patient factors. Online survey among recently diagnosed T2D patients recruited in the Netherlands and the United Kingdom (UK). Patient factors included general factors and behaviour-specific beliefs. Logistic regression analyses and explorative comparisons were conducted. Overall, 48% of 67 patients were willing to engage in all three management options, whereas 6% were not willing to follow any of them. 73% were willing to manage T2D with healthy eating, 73% with physical activity, and 72% with medication. Country of recruitment was significantly associated with willingness for healthy eating, with higher willingness among Dutch participants. Beliefs surrounding capability, opportunity, and motivation were significantly associated with willingness to engage in physical activity and medication taking. Many beliefs were similar regardless of willingness but those willing to engage in physical activity perceived less barriers and those willing to take medication had more positive and less negative outcome beliefs than those not willing. Willingness to engage in all management options was limited among recently diagnosed patients, and partly associated with behaviour-specific patient beliefs. • Willingness for diabetes management with all options is limited in recently diagnosed people. • People willing or not willing to engage in a management option shared similar beliefs. • Capability-opportunity-motivation beliefs were relevant for some of the options. • Willingness to follow a recommended diet differed between countries of recruitment. [ABSTRACT FROM AUTHOR]

IL-33 is one of the novel IL-1 family members which are secreted in many tissues. Osteopontin (OPN) is a highly phosphorylated and glycosylated sialoprotein synthesized primarily in bone tissue, which the major role is to participate in biomineralization. Both IL-33 and OPN are mentioned associated with inflammatory disorders. Diabetes Mellitus Type 2 (T2DM) is a metabolic disorder in glucose homeostasis, which its pathophysiology involves a low-grade chronic inflammation. The aim of this study is to evaluate the IL-33 and OPN levels in well and poorly regulated T2DM patients. Three group were determined as; T2DM with HbA1c level below 8% as Group HbA1c <8, T2DM with HbA1c level of 8% and above as Group HbA1c ≥8, and control group consisting of healthy individuals respectively. Each group included 50 participant (n=50). Age, fasting plasma glucose, HbA1c and lipid parameters (total cholesterol, triglyceride, LDL, HDL), IL-33 and OPN values were examined. There was a significant statistical difference between the fasting plasma glucose, HbA1c, triglyceride, and HDL levels of the groups (p<0.001). OPN levels of the groups were not found statistically different but IL-33 levels were found to be significantly higher in the HbA1c <8 group compared to the control group (p=0.0108). IL-33 and OPN levels do not differ in terms of well or poorly regulation in T2DM patients and HbA1c level alone, is insufficient to be a predictor of OPN and IL-33 activity [ABSTRACT FROM AUTHOR]

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Diabetes mellitus type 2 (DM2) is a hypercoagulable state with enhanced platelet (PLT) activation and increased clotting factor production. Simultaneously, the fibrinolytic cell system is inhibited due to the formation of clots with high fibrinolysis resistance. The stages of PLT "activation" have been well characterized microscopically, morphometrically, and nanomechanically using a light microscope, transmission electron microscope (TEM), scanning electron microscope (SEM), and atomic force microscope (AFM). Thrombocytes in an "activated" (procoagulant) state play a central role in two main biological processes: hemostasis and vascular vessel repair. Enhanced PLT reactivity in diabetic patients is considered a "pro-thrombotic" state. PLT hematometric indices are higher in retrospective and prospective studies, such as PLTs (count), MPV (mean platelet volume), PDW (platelet distribution width), PCR (platelet crit), and the PLTs/Ly ratio. The platelet indices MPV and PDW are higher in people with diabetes who have chronic vascular complications, and are statistically significant. PLT parameters/indices are useful biomarkers in the early diagnosis and prognosis of DM2. Precise studies of PLT activation state during DM2 may be useful for new diabetes (DM2) treatment strategies and effective therapeutic agents. Researchers have observed an association between MPV and medications such as insulin, metformin, and sulfonylureas using the blood glucose concentration attached to hemoglobin (HbA1c values) as markers of glycemic control in patients with diabetes. Computational modeling of PLT activation in DM2 is also a controlling factor for thrombocyte distribution and margination in blood vessels, both of which are associated with micro- and macrovascular disease in DM2. PLT-derived microRNAs (miRNAs) are novel molecular biomarkers for the diagnosis and prognosis of DM2, insulin resistance, and diabetes complications. Anti-platelet agents and natural plant products may also be effective in the prevention and secondary treatment of micro- and macrovascular complications in type 2 diabetes mellitus. To determine new ways of diagnosing, treating, predicting, and managing DM2 and its related vascular complications, we propose monitoring a combination of hematological, hemorheological, and hemostatic parameters (indices), which merit future studies. [ABSTRACT FROM AUTHOR]

Background. Myostatin (Mstn) plays an important role in adipocyte growth, differentiation and metabolism, leading to the development of obesity. Objectives. We aimed to explore the effect of Mstn on white fat browning in a mouse model of type 2 diabetes mellitus (T2DM). Materials and methods: Twelve wild-type (WT), 12 heterozygous (Mstn(+/-)) and 12 homozygous (Mstn(-/-)) male mice were randomly divided into 6 groups: WT, Mstn(+/-), Mstn(-/-), WT+DM, Mstn(+/-)+DM, and Mstn(-/-)+DM. The first 3 groups were fed normal chow, while the last 3 were fed high-fat diet and administered streptozotocin to generate T2DM. Subsequently, body mass, length, and white and brown fat masses were measured, after which Lee's index, white-brown ratio and fat index were calculated. The serum free fatty acid (FFA) levels were detected using enzyme-linked immunosorbent assay (ELISA). Hematoxylin and eosin (H&E) staining was used to analyze white and brown fat cell morphology. The relative expression levels of peroxisome proliferator-activated receptor-gamma (PPARγ), peroxisome proliferator-activated receptor-gamma coactivator-1 alpha (PGC-1a), uncoupling protein 1 (UCP1), and cluster of differentiation 137 (CD137) protein were determined with western blotting. Results: The Mstn(-/-) group displayed higher levels of PPARγ, PGC-1a and CD137 proteins in white and brown fat compared to the WT and Mstn(+/-) groups, while the expression level of UCP1 protein in the Mstn(-/-) group was higher than in the WT group. The expression levels of PPARγ, PGC-1a, UCP1, and CD137 proteins in the WT+DM group were lower than in the WT group. Moreover, PPARγ, PGC-1a, UCP1, and CD137 proteins were more highly expressed in the Mstn(-/-)+DM group compared to the WT+DM and Mstn(+/-)+DM groups. Conclusions. The Mstn gene inhibition antagonizes obesity phenotypes, such as white fat accumulation and lipid metabolism derangement caused by T2DM, thus promoting white fat browning. [ABSTRACT FROM AUTHOR]

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Introduction and objective: Berberine (BBR) is an isoquinoline alkaloid extracted from various plants. It has been utilized for millennia in traditional Chinese and Ayurvedic medicine. A growing body of evidence supports the beneficial effects of BBR in the treatment of type 2 diabetes mellitus (T2DM) and in reducing the risk of developing related complications. The aim of this study is to review the existing knowledge on the efficacy and safety of BBR in the treatment of T2DM and associated dementia, based on the available scientific literature. Material and Methods: A review of the literature available in the PubMed database was conducted using the following search terms: Berberine; Diabetes Mellitus Type 2; Vascular Dementia; Alzheimer Disease. Current knowledge: The pharmacological treatments of both T2DM and AD have been associated with relatively low efficacy, a high financial burden, and numerous complications that significantly impact patients' daily lives. The exact mechanisms of action of berberine remain unclear. Summary: BBR may be an attractive option for the treatment of T2DM and associated dementia, with therapeutic effects similar to oral hypoglycemic agents, promising neuroprotective properties, a reduced risk of adverse reactions and lower cost. Moreover, BBR improves cerebral blood flow and memory in the rat model of AD. Further scientific research is required to determine the long-term outcomes of this treatment.

Background: Diabetes mellitus is significantly related to cardiovascular disease, such as atherosclerosis. Antioxidants are essential in the prevention of atherosclerosis by a variety of mechanisms, which encompass the suppression of free radical production, inhibition of low-density lipoprotein oxidation, and prevention of atherosclerotic plaque formation. Objectives: This study aims to evaluate the levels of total antioxidant capacity and malondialdehyde as oxidative stress indicators in Iraqi type 2 diabetes mellitus (T2DM) patients and investigate their relationship with atherosclerotic risk factors. Methods: This case-control study took place between October 2023 to January 2024 at Al-Karkh General Hospital in Baghdad. The study included a total of 130 participants: 70 individuals diagnosed with T2DM and 60 healthy controls were recruited from relatives of patients attending the hospital and hospital employees who did not have T2DM. The two study groups were age-matched. Blood samples from both groups were analyzed to determine the following parameters: Lipid profile, total antioxidant capacity (TAC), Malondialdehyde (MDA) as an oxidative stress marker, glycated hemoglobin (HbA1c), and atherogenic indices (e.g. atherogenic index of plasma). Results: The mean serum total antioxidant capacity (TAC) in the T2DM group was significantly lower than the control group (46.9 ± 5.05 U/mL vs. 70.8 ± 4.71 U/mL). This indicates a highly significant difference between the groups. Additionally, in the T2DM group, statistically significant inverse correlations were observed between TAC and most of the measured lipid profile parameters, HbA1c, and atherogenic indices. Conclusions: Low TAC may be a potential predictor of atherosclerosis in Τ2DM patients and highlight the relationship between oxidative stress, lipid metabolism, and thermogenesis.